Transcript Legislative Health Care Workforce Commission Graduate
Legislative Health Care Workforce Commission Graduate Medical Education
Troy Taubenheim
M e t r o M i n n e s o t a C o u n c i l o n G ra d u a t e M e d i c a l E d u c a t i o n A u g u s t 2 5 , 2 0 1 4
Overview
GME Basics Resident Supply and Demand Funding Threats Licensure Counts Summary
GME….What is it?
The term “Graduate Medical Education” (GME) refers to the extensive training a graduate
from
medical school must complete before becoming a fully trained, independent physician eligible for Board Certification.
GME Requirements
Newly graduated medical students must receive additional training under the supervision of a fully trained physician.
The physician in training is referred to as a “resident” or “resident physician”.
The principal setting for the training is in a teaching hospital.
Physician Training
Training of a physician takes anywhere from (7)* to (11)** years following the completion of a traditional four-year college degree.
Educational pathway of a fully trained cardiologist Medical Student Begins Education 4 Years Medical School 3 Years Residency Training in General Internal Medicine 3 Years Fellowship Training In Cardiovascular Disease Fully Trained Cardiologist * 4 years medical school and 3 years residency training ** 4 years medical school 7 years residency training
How Governmental Funding Works
1. Programs hire residents 2. Residents train at affiliate hospitals 5. Programs pay residents & continue services 4. Hospitals pay programs for resident stipend benefits 3. Hospitals receive governmental funding for resident time 6
Federal Programs that Pay for GME
•
Medicare (CMS Hospitals)
• Medicaid (Medical Assistance) • Veterans Hospitals and Health Systems • HRSA (Children’s Hospitals) • Teaching Health Centers (THCGME) • Department of Defense
GME Funding
The Centers for Medicare and Medicaid Services (CMS) provides reimbursement to hospitals for Graduate Medical Education CMS Reimbursement (Minnesota Averages)
DME – Direct Medical Education (Avg. $24,000)
IME – Indirect Medical Education (Avg. $84,000)
FTE Cap for both DME and IME
Hospital-Specific Based on 1996 Volumes
MN Cap = 1,600 MN program totals = 2,300
Medical Education & Research Costs (MERC)
Minnesota Specific Legislative Funding Currently about $57 million in combined state and federal dollars
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What are DGME Payments intended to cover?
Compensate teaching institutions for Medicare’s share of the costs directly related to educating residents: Residents’ stipends/fringe benefits Salaries/fringe benefits of supervising faculty Other direct costs Allocated overhead costs Residents must be in approved programs DGME payments are based on the Medicare % of patient days.
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Medicare Payments with an Education Label: IME
Compensates teaching hospitals for higher inpatient operating costs due to: Unmeasured patient complexity not captured by the DRG system Other operating costs associated with being a teaching hospital (lower productivity, standby capacity, etc.) Percentage add on-payment to basic Medicare per case (DRG) payment
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Minnesota GME Sponsors
Mayo Clinic College of Medicine Abbott-Northwestern Hospital/Allina Health System Allina Health / United Family Medicine Hennepin County Medical Center Twin Cities Spine HealthPartners Institute for Education and Research Tria Orthopaedic Center Fairview Southdale Hospital University of Minnesota Medical School
Minnesota Teaching Hospitals
Abbott Northwestern Children’s Hospitals Gillette Children’s Hennepin County MC Mayo-Mankato Methodist-Park Nicollet North Memorial Regions Hospital Rochester Methodist St. Joseph’s St. John’s St. Mary’s Duluth St. Mary’s Rochester St. Cloud Hospital St. Luke’s Duluth UMMC-Fairview VA Health System
MMCGME Trainees by Specialty Category
1,275 Accredited FTEs Primary Care includes: family medicine, general internal medicine, and general pediatrics Expanded Primary Care includes: general surgery, psychiatry, and obstetrics
Minnesota Physicians by Age
Active MN licensed physicians practicing in Minnesota = 13,272 43% are age 56 or older Age Range 28-35 36-45 46-55 56-65 66-79
Grand Total
Age 56 plus Count 800 2,321 4,409 4,824 918
13,272
5,742 43%
Medical Students vs. Residency Slots
Unless Congress lifts the 16 year cap on federal support for residency training, we will face a shortfall of physicians across dozens of specialties Students are doing their part by applying to medical school in record numbers Medical schools are doing their part by expanding enrollment Now Congress needs to do its part to expand residency training to ensure that everyone who needs a doctor has access to one
Residency and the Match
2013 R ESIDENCY A PPLICATIONS
17,487 US MD
1097
2,677 US DO
658
1,487 Prev US MD
758
5,095 US Int’l
2389
7,568 Int’l
34,314 TOTAL 3967 2016 R ESIDENCY A PPLICATIONS
21,000 US MD 6,000 US DO
27,000 TOTAL
26,000 AVAILABLE ACGME SLOTS
Sources: AAMC, AACOM, NRMP
GME Funding Threats
IOM Report July 29, 2014 (35% reduction) Presidential budget recommended reducing IME by 10% Impact of $9 billion over 10 years Simpson-Bowles deficit commission proposed Cutting IME by 60% Limit DGME payments to 120% of the national average salary paid to residents in 2010 Impact of $60 billion over 10 years Unreliable MERC Funding (Minnesota Specific Funding) Cut by 50% in 2011 Restored in 2013
GME Value Beyond CMS
Mission Physician workforce recruitment Future referrals (i.e. by former trainees) Faculty non-clinical productivity Institutional reputation Research Clinical revenue Net clinical productivity Leveraged professional fees Clinical cost savings Patient outcomes Education of medical students Faculty recruitment Address patient quality issues
2013 MMCGME Trainee Disposition
Of graduates entering medical practice:
•
61% remained in MN (23% in Greater MN)
•
70% remained in the region
Summary
Retirement rate exceeds current training GME is the bottleneck for more physicians and the training is long term.
The number of training slots funded is capped by CMS.
Funding is less than costs and is at risk.
Medical School graduates are increasing and resident slots is static.
Physicians trained in MN stay in MN.
40% of Programs are Primary Care
What Can Be Done
Stabilize and Increase Clinical Training Opportunities Increase State Funding through MERC Incentivize Primary Care Residents to work in Primary Care Engage other Stakeholders Non-Teaching Hospitals Practice Plans Business and Industry Health Plans